Worried about herpes

[Catullus81]

First of all, I have been with the same sexual partner for almost a year, and she was recently tested for STDs, and everything came back negative.  In the past two years I have had three other sexual partners, and we always used condoms during intercourse.

About two weeks ago, after having much sex I developed a friction burn on my penis.  The next day the area surrounding the friction burn was very swollen and hard.  The swelling quickly went down and scabs began to form.  

Five days after the scabs began to form I noticed a small red rash on my penis to the left of the friction burn, and then a blister began to form in the center of the rash, followed by two other blisters nearby.  This never once hurt at all.  No pain.  The blisters are round, shiny, clear or whitish, and firm.  They never turned into ulcers, but as they healed there is a pale brown scab, and the skin around the scab is swollen and pink.  Again, there is no pain, even if I touch it.

But, as those blisters began to heal, more blisters appeared to the right side of the friction burn.  First, a red rash, and then three blisters grouped near each other, and then below that there are three more spread out in a line.  The area that the blisters occupy is red and a bit swollen.  

If my current partner is indeed free of herpes, could I have been infected with herpes for years before having such an outbreak as I described?  

Is it possible that this is anything other than herpes?  

It is going to be a number of days before I get my test results.  Are there any symptoms that I should be looking out for or concerned about?  

[Edward W Hook, MD]

Your results indicate the you have HSV-2 although they do not tell you how long you have had it, where your outbreaks occur or whether the OB you describe was HSV.  The data also suggest that you have had the infection for more than a few weeks at least because it is uncommon for the tests to come positive in the 1rst 2-3 weeks following infection.  

There is much to be learned about HSV and there is a great source for it, -the American Social Health Association (AHSA) web site  (disclosure, both Dr, Handsfield and I are on the ASHA Board of Directors).  Briefly, some of the things you should read about there include:

1.  Measures to avoid transmission of infection.  These include disclosure to partners, condoms and chronic suppressive therapy with antiviral medications.
2.  the fact that the infection can be transmitted to sex partners in the absence of lesions because the virus can be present on intact, normal appearing skin (so called "asymptomatic shedding".
And much more

In general some people do have "triggers" for OBs which might include stress or fatigue. It varies from person to person.

While lysine has been suggested as therapy it has not been proven to be of benefit in scientific studies.  Nor has elimination of caffeine.

Finally, consider having you partner get a blood test too.  Over 90% of persons with HSV do not know it.  If she is amongst them the knowledge will be helpful to you with regarding to concerns about transmission since if she already has it, she cannot get it again.

Hope this is helpful.  EWH

[Catullus81]

I just received the results of my IgG test and I am negative for HSV1 but positive for HSV2, and the numeric value is 4.56.  So, I guess there is little chance of a false positive?  Do these numbers have any other significance?  Can they tell me any more about how long I have been infected or what I can expect from my infection in the future?

My outbreak was not painful, had no ulcers, but did blister and leave unsightly scabs.  I go to the gym 5-6 days a week and shower in front of other men.  Embarrassing.  Is it likely that my OB will always blister and leave scabs?

I live a healthy lifestyle, so I eat well and exercise, and I will greatly reduce my alcohol consumption.  Can I ask a doctor for a daily anti-viral to suppress outbreaks?  Is L-lysine worth taking, and how much should I take?   I have read recommended dosages from 1250 to 8000mg!  Can you recommend a trustworthy brand?  Can I still eat black beans and tofu?  Should I eliminate the 200mg of caffeine I take each day?  

I often suffer from depression.  I work hard to live a lifestyle that supports a healthy mood, but it is always a delicate balance, and I am afraid that the depression and the herpes will work together to really bring me down.  Would an anti-depressant be useful?

I was severely jet-lagged when this outbreak occurred.  So, I am not sure if the run-down feeling I had was from the herpes or the plane ride.  If it was the herpes, will I experience those symptoms during each OB?  If I do feel run-down, is it OK to force myself to exercise anyway?

I know that the despair and worthlessness that I am feeling will pass.  I know that I am going to have to make some changes in my lifestyle.  But, I have decided that I am going to force this virus to make me a better, healthier person.  I just want to limit and control the outbreaks to avoid the feelings of embarrassment and the stigma that this virus has brought to me.

[Edward W Hook, MD]

While you asked "Is it possible that this is anything other than herpes? ", I am confident that it is not.  You indicate the your rash occurred in an area of trauma (friction burn), was painless, did not ulcerate,  and that your partner does not have HSV. Taking these facts together,  the chance that you got HSV from her is quite low.  I supposed that you could have acquired HSV in the past and missed it but that too  is unlikely and would not be expected to present that way.

In contrast, a blistering rash is not uncommon following trauma and the lesions and description of the time course you provide is very compatible with a dermatological reaction to local trauma.  

You indicate the you have been tested.  I presume this is a blood test. If the result is positive, it is unlikely to be due to the lesions you describe.  My advice is to not worry. If you test is positive let me know and we can discuss but I anticipate it will be negative.

Take care.  EWH